UNRECOGNIZED DIABETES AMONG HOSPITALIZED-PATIENTS

OBJECTIVE - To evaluate the hospital care rendered to hyperglycemic in dividuals who did not have a diagnosis of diabetes before admission. R ESEARCH DESIGN AND METHODS - A total of 1,034 consecutively hospitaliz ed adult patients at a 750-bed inner-city teaching hospital were evalu ated. Patients with one or more plasma glucose values >200 mg/dl were identified by the laboratory data system on a daily basis. Patients wi thout a diagnosis of diabetes at the time of admission were evaluated to determine if and how physicians addressed the hyperglycemia, whethe r a new diagnosis of diabetes was made during admission, and whether f ollow-up was planned to address the hyperglycemia. RESULTS - After exc luding patients who were admitted for a primary diagnosis of diabetes, 37.5% of all hyperglycemic medical patients and 33% of hyperglycemic surgical patients were without a diagnosis of diabetes at the time of admission. These patients had a mean peak glucose of 299 mg/dl, and 66 % had two or more elevated values during their hospitalization. Fifty- four percent received insulin therapy and 59% received bedside glucose monitoring, yet 66% of daily patient progress notes failed to comment on the presence of hyperglycemia or diabetes. Diabetes was documented in only three patients (7.3%) as a possible diagnosis in the daily pr ogress notes. CONCLUSIONS - Despite marked hyperglycemia, most medical records made no reference to the possibility of unrecognized diabetes . Given the average delay of a decade between the onset and diagnosis of type 2 diabetes, further evaluation of hyperglycemic hospitalized p atients may present an important opportunity for earlier detection and the initiation of therapy.